Non-invasive breast cancer can be either ductal carcinoma in situ or less commonly lobular carcinoma in situ. Ductal carcinoma in situ is of epithelial type, and there is usually no basement membrane invasiveness. Because of the lack of invasiveness, these tumors are unlikely to metastasize by the lymphatics or blood vessels. Ductal carcinoma in situ is usually diagnosed by a mammography and not by physical examination. Microcalcifications on mammography are the most common presenting feature. Local excision of the lesion is recommended to obtain histopathologic data and guide treatment. Total mastectomy or breast conservation therapy are the two options for the treatment of ductal carcinoma in situ.

00:01
Our topic now brings
us to breast cancer.
00:04
A couple of things that we want
to make sure that we go throughwith malignant breast
cancer is, well,who is your patient and
what are some risk factors.
00:14
A lot of this we’ve kind of
already talked about withour molecular pathology.
00:18
Let’s put everything
together here.
00:20
Commonly, you’ll find this
postmenopausal, not always.
00:24
Arises from the mammary
duct epitheliumand, later on, when we get
into clinical anatomy,I’ll show you the glands
that are affected.
00:33
Students often get the lactiferous
and the lobule confused,but they’re two
different entities.
00:39
The lactiferous sinus will
be located by the breast.
00:41
The lobule will be
closer to the stroma.
00:45
What are you worried
about with breast cancerespecially if it’s malignancy?Let’s set up the
foundation here.
00:50
You’re going to test your patient
for estrogen and progesterone.
00:54
We call this ER/PR,estrogen or progesterone
receptor positive.
00:58
If your patient tests positive
for estrogen receptor,then this to you means
that maybe perhapsyou can use drugs such as
tamoxifen or raloxifene.
01:09
The other major genetic test that you
want to keep in mind is called ERBB2.
01:13
You have two breasts, ERBB2.
01:17
Another name for
this is HER2/neu.
01:21
You focus upon HER2
and in neoplasia,we talked about HER2/neuand we call this an epidermal
growth factor receptor.
01:30
This is an epidermal growth
factor receptor pathology.
01:33
And if this takes place and
you find this to be positive,then you should be thinking about
drugs such as your trastuzumab.
01:41
The number one
prognostic indicator,I’ve mentioned this a few times,will be the axillary lymph node.
01:46
And if the axillary
lymph node is involved,then your prognosis
drops like crazy.
01:51
The most common placethat you would find tumors
in general would be --what part of the breast?I’ll show you a picture coming upin which majority of percentageof your breast tumors will be
located in the upper quadrant.
02:04
Upper outer quadrant.
02:07
What are my risk factors for
malignant breast cancer?They include the following:Estrogen exposure,so any female that has
exposure to increased estrogenincluding hormone
replacement therapy,including early menarche,
late menopause,including the fact that shemight be suffering from
polycystic ovarian syndrome.
02:29
Increased total number
of menstrual cycles,that would then mean what?Increased exposure to estrogen.
02:35
Use your physiology
to understandwhy increased number of menstrual
cycles could increase the risk.
02:42
Live birth and obesity.
02:44
Obesity once again,the more obese a female
is, the more adipocyte,and the name of the
enzyme there is called?Aromatization.
02:53
Therefore, once again,
increased estrogen.
02:56
Eventually, the risk factor
that you want to keep in mindis obesity associated with
increased estrgen exposure.
03:04
Remember a couple patients here,just a female who’s obese or
polycystic ovarian syndrome.
03:10
Many of your patients especially
postmenopausalare associated with obesity.
03:15
That, you very much
want to keep in mind.

About the Lecture

The lecture Morphology of Breast Carcinoma by Carlo Raj, MD is from the course Breast Disease.

Included Quiz Questions

Which of the following is a type of breast cancer that should be treated with trastuzumab?

HER2/neu receptor positive

Estrogen receptor positive

Intraductal papilloma

Mammary duct ecstasia

Progesterone receptor positive

What should be used to treat estrogen receptor-positive breast cancers?

Tamoxifen

Trastuzumab

None of the answers are correct

Total mastectomy

Oral contraceptives

Which of the following statements about the morphology of breast carcinoma is INCORRECT?

Excessive estrogen exposure is negatively correlated with incidence.

It arises from mammary duct epithelium or lobular glands.

Its most common location is in the upper-outer quadrant of the breast.

The axillary node involvement is the single-most important prognostic factor.

It commonly affects postmenopausal women.

Author of lecture Morphology of Breast Carcinoma

Carlo Raj, MD

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